Healthcare Provider Details

I. General information

NPI: 1720932965
Provider Name (Legal Business Name): IMPACT HEALTH AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 02/24/2026
Certification Date: 02/24/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6301 IVY LN STE 700
GREENBELT MD
20770-6330
US

IV. Provider business mailing address

6301 IVY LN STE 700
GREENBELT MD
20770-6330
US

V. Phone/Fax

Practice location:
  • Phone: 443-599-9288
  • Fax: 443-499-9433
Mailing address:
  • Phone: 443-599-9288
  • Fax: 443-499-9433

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. STEPHANIE C ANYAOHA
Title or Position: CEO/FOUNDER
Credential: PMHNP-BC
Phone: 443-599-9288